How To Get Better Quality Sleep
Sleep by Rikki Aherne
Sleep is a naturally occurring state that is an important part of our daily routine. Getting enough good quality sleep is as essential as getting enough food and water. Sleep is important for a number of brain and bodily functions, including metabolism and immune function, as well as regulating mood and resisting disease. Recent research suggests that good quality sleep removes toxins from the brain that have accumulated during the day.
Research also tells us that poor quality sleep can lead to a higher risk of heart disease, diabetes, depression and obesity.
Types of Sleep
There are two main types of sleep, REM (rapid eye movement) and non-REM. Each type of sleep is associated with specific brain waves and activity.
You cycle through non-REM and REM sleep several times throughout the night. Non-REM sleep has three stages and REM has just one.
This is known as the dozing stage. It is non-REM sleep which only lasts a few minutes. It signifies the change from being awake to being asleep.
This stage is characterised by the slowing down of your heart rate and breathing. It is not uncommon for muscles to twitch during this stage. Brain waves start to slow down.
This is known as the light sleep stage. It is a non-REM sleep which lasts around 10-25 minutes during the first sleep cycle. As the night continues, this time gets longer with each subsequent cycle.
This stage is characterised by the slowing down of your heart rate and breathing. Your muscles become more relaxed and your eyes stop moving. Brain waves slow further with occasional bursts of activity.
You spend around 50% of your sleep cycle in this stage.
This is known as the deep sleep stage. It is a non-REM sleep which lasts 20-40 minutes during the first sleep cycle. As the night continues, this time gets shorter with each subsequent cycle.
This stage is characterised by the slowing down (to the lowest level during sleep) of heart rate and breathing. Muscles are even more relaxed and it is usually difficult to wake someone. Brain waves slow even further.
Research suggests that this is a restorative stage. During this part of the cycle, the immune system and bodily functions are boosted. This stage is the stage that allows you to wake up feeling refreshed in the morning. It is associated with insightful thinking, creativity and memory.
This is the rapid eye movement stage. It begins around 90 minutes after falling asleep and lasts only a few minutes during the first sleep cycle. As the night continues, REM sleep gets longer, lasting for around 1 hour.
This stage is characterised by the speeding up of heart rate and breathing, nearing awake levels. Muscles are temporarily paralysed with the exception of those used for breathing and the eye muscles. Brain wave activity increases to near wakeful levels.
Research suggests that most of our dreaming occurs during REM sleep. You can dream in the non-REM stages but the dreams are much less vivid. REM sleep is essential for cognitive functions such as consolidating learning as well as creativity and memory
You spend around 25% of your sleep cycle in this stage.
Each cycle lasts from 90 - 120 minutes. This means that we have four or five cycles for every 8 hours of sleep.
Why Can’t I Sleep?
Sleep stages are important as they allow the mind and body to recuperate and develop. Those who frequently wake up during the earlier stages may not be sufficiently reaching the deeper sleep stages.
Insufficient sleep can have a profoundly negative effect on emotional stability, overall mental health as well as your physical health.
Research links consistent lack of good quality sleep with heart disease, high blood pressure, diabetes and obesity. It is also linked to increased incidence of anxiety, depression and stress.
Sleep stages follow a fairly typical pattern. This pattern can vary widely between individuals based on several factors.
Changes in patterns of sleep occur with age. Newborns spend around 50% of their sleep cycle in REM sleep. By the age of around 5, children have similar sleep patterns to adults. Elderly people tend to spend less time in REM sleep.
This reduction in REM sleep can make it seem like older people don’t get enough sleep. In actual fact, the length of sleep stays fairly consistent, it’s the amount of deep sleep that reduces. This makes you feel less refreshed when you wake up and more easily woken during the night from the lighter stages of sleep.
Alcohol is a central nervous system depressant. It often allows you to fall asleep more quickly and you generally enter the deeper sleep stages earlier. But, as the night goes on, this can create an imbalance between non-REM and REM sleep. This results in more non-REM sleep and we know that this can lead to waking more easily and often, as well as having less quality and quantity of sleep.
The term sleep disorder refers to conditions which affect sleep quality, duration or timing. These conditions affect your ability to function in everyday life. Over 100 specific sleep disorders have now been identified and classified. Some of these include:
Insomnia is defined as regularly struggling to fall asleep. You wake several times in the night and you feel tired during the following day. It is the most common sleep disorder.
There are three types of insomnia: transient, acute and chronic.
Transient insomnia lasts for less than a week. If it often caused by changes in the sleep environment, stress or depression.
Acute insomnia lasts up to one month and is usually the result of an acute stressor. This insomnia resolves once the stressor is dealt with.
Chronic insomnia lasts for more than one month. It is usually caused by chronic physical or mental health issues.
Narcolepsy is a chronic sleep disorder which is characterised by extreme daytime drowsiness and sudden onset of sleep. It is a fairly rare condition affecting around 30,000 people in the UK. Narcolepsy is often caused by a lack of the chemical hypocretin in the brain. Hypocretin regulates wakefulness. The immune system attacks the cells that produce it or attack the receptors which allow it to work. There is currently no cure for narcolepsy. It doesn’t cause serious or long-term health problems, but it can significantly impact your daily life and be difficult to cope with. Improving your sleeping habits and taking medication can help minimise the impact it has on your everyday life.
Sleep apnoea is a potentially serious sleep disorder. It is characterised by stopping and starting breathing throughout the night. It happens when your airway becomes relaxed and narrow, or closes, as you sleep. An estimated 20-30% of adults have sleep apnoea. The most common type is obstructive sleep apnoea. Symptoms include breathing which stops and starts, snorting or choking noises, loud snoring and frequently waking in the night. You may have a headache when you wake up and during the day, you may also feel very tired and find it hard to concentrate. The most common treatment for sleep apnoea is the use of a CPAP machine. A mask is worn over the mouth or nose as you sleep. This pumps air into your airway to help keep it open during the night.
Restless Leg Syndrome
Restless Leg Syndrome is characterised by the overwhelming urge to move your legs or having strange sensations in them. It is a common condition which can affect anyone at any point in their life. Women are twice as likely as men to develop it, especially during pregnancy. It is also more common in middle age.
The symptoms of Restless Leg Syndrome can vary from mild to severe. It doesn’t cause serious health problems but it can lead to insomnia, anxiety and depression which can be difficult to cope with.
Parasomnia is a sleep disorder which causes abnormal behaviour during sleep. The behaviour may occur at any stage of the sleep cycle and may include talking, moving, bed wetting, emotional arousal and abnormal perceptions and dreams. You typically do not remember any incident that occurs. Parasomnias are fairly common but they can make it difficult to get good quality sleep and disrupt the sleep of others around you. They can also be dangerous because you are unaware of your surroundings and they may also cause psychological distress. Sleep-walking and sleep-talking are common parasomnias. Sleep-walking happens during the earlier sleep stages whereas sleep-talking can happen at any stage.
Night terrors cause you to suddenly wake up in a terrified state. This state lasts 30 seconds to 5 minutes. Night terrors are characterised by crying, screaming, sweating and an increased heart rate. Night terrors differ from nightmares in that the usually involve little to no dream activity.
REM sleep behaviour disorder is acting out vivid dreams during REM sleep. You usually wake up easily and remember the dream. Typical REM sleep behaviour disorder includes punching, kicking, shouting and jumping.
There are many possible causes of parasomnias. These may include stress, anxiety, depression, substance abuse, shift work, medications and neurological conditions such as Parkinson’s disease.
Emotional or Psychological Factors
There is a close relationship between sleep and mental health. Living with a mental health issue can make it difficult to sleep whilst having difficulty sleeping can negatively impact your mental health. It is a cycle that can be broken by treating the underlying issue.
If you are having problems sleeping you may find:
You feel more anxious or depressed.
Your existing symptoms may be worse. You may suffer psychotic episodes, mania or paranoia.
You feel isolated and lonely.
You struggle to concentrate, make plans or make decisions.
You feel irritable or have no energy.
Working on your mental health and sleep hygiene can make these problems more manageable.
Shift work is generally categorised as working outside the hours of 6am to 7pm. These shifts can cover nights, early mornings or a mixture of both.
Working these atypical patterns can disrupt the natural circadian rhythm. This rhythm is an internal body clock which regulates the sleep-wake cycle over a 24 hour period. This disruption can lead to shift work disorder. Shift work disorder is characterised by a misalignment between the body and the circadian rhythms that regulate the sleep-wake cycle and manifests as excessive sleepiness, difficulty falling asleep and fatigue, all of which disrupts daily life. Shift workers have a higher prevalence of insomnia and mental health problems compared to non-shift workers.
What Can I Do?
Everyone has the occasional night, or spell of nights, where they struggle to sleep. Understanding what may be causing them and, more importantly, how you can make changes, can help you to get better quality sleep.
Whilst you don’t always have complete control of your body’s natural sleep cycle, there are steps you can take to improve your sleep habits and therefore your chances of getting better quality sleep.
Keep a Sleep Diary
As soon as you recognise that you have a problem, start to keep a sleep diary. Keep the diary over a 2 week period. A sleep diary can help you pinpoint a specific behaviour or set of behaviours which may be affecting your sleep cycle.
A sleep diary records important sleep related information. Whilst all diaries are different, they tend to follow this structure:
To ensure your sleep diary is accurate, fill it in as you go. This helps to avoid any gaps in memory. It is important that you check in on your sleep hygiene at the end of the process.
Am I allowing enough time for sleep?
Is my routine consistent or does it fluctuate?
Am I spending long periods of time in bed unable to sleep?
Is my sleep disrupted in the night? Is there an identifiable pattern?
Is my sleep satisfying?
How am I feeling in the morning?
Am I using any medications/caffeine/alcohol/food that is affecting my sleep?
By analysing your diary and asking yourself these questions you can start to identify why you may be struggling to sleep. You can then find opportunities to change behaviours and use practical solutions to improve your quality of sleep.
Have a Consistent Routine
Keeping a consistent sleep schedule maintains the timing of your body’s internal clock.
Go to bed and get up at the same time everyday, even on weekends or days off work.
Finding an ideal sleep schedule starts with making consistency a priority. By being consistent you are embedding good habits and routines. This will make it easier to fall asleep and stay asleep so you can wake up feeling refreshed.
Choose a bedtime and a wake up time. Allow the times to offer you ample sleeping hours. Everyone will have different sleep needs so begin by allowing for 7-9 hours of sleep per night.
It can be hard to adjust to a new sleep schedule; it takes time to get used to. In order to make it easier, begin by making adjustments of 15-30 increments over several days until you reach your goal sleep and wake times. You can also try focusing on just one part of the schedule at a time, for example, setting a wake up time and being consistent with that. You may then find it easier to stick to a set bedtime.
The circadian rhythm naturally aligns with the environment around you. It produces hormones to make you feel awake in the daylight and hormones to make you feel drowsy when it is dark. You should therefore try to wake up when the daylight starts and begin to wind down for bed when the dark comes. People with different work patterns and those living in different geographical locations will have widely differing daylight hours so it can be difficult to stick to this particular routine. If this is not possible, aim to align as closely to day and night as possible.
Make Your Bedroom Sleep Friendly
Make your bedroom a sacred place. Only use it for sleeping and sex. This association conditions your brain to relate the bedroom to relaxation and sleep.
Keep phones, tablets, games, work papers and exercise equipment in another room as these can distract the mind and associate the bedroom with activity rather than rest.
Limit the amount of outside noise. Noise whilst you sleep can not only make it difficult to fall asleep but it can disrupt you whilst you sleep. Noise has been shown to increase stage 1 sleep and decrease REM sleep. This results in you waking up more easily during the night and waking up feeling less refreshed. There are some noises you can control such as the TV in the other room or the washing machine on a spin cycle, but there are some noises that you can’t, such as the neighbours’ dog barking or traffic on the street. For those things you can’t control, some find it useful to drown them out. You can purchase a white noise machine. There are also ear plugs and headphones specifically designed for use whilst sleeping.
Limit the amount of light. Light stimulates the circadian rhythm to tell your body that it’s daylight and that you should wake up. This suppresses the ability to feel drowsy and to sleep. Light exposure in the hour before you go to bed can send the same signal. This light can be natural light but artificial light can have the same effect. Installing a dimmer switch allows you to gradually lower the light levels in the room to signal your body that it’s time to sleep.
Set the right temperature. Our core body temperature is around 37 °C but it tends to drop throughout the night. This drop in temperature begins around 2 hours before you go to sleep. This is an integral part of your circadian rhythm, signalling that it is time for bed. In this respect room temperature is important when it comes to getting a good nights sleep. The ideal range is 15.6 - 22 °C.
Your circadian rhythm is largely dependent on light cues. When the sun rises in the morning, your body produces cortisol, a hormone which makes you feel awake and alert. When the sun goes down, your body releases melatonin, a hormone which makes you feel sleepy.
Electronic devices such as phones, tablets, e-readers and computers emit blue light. This blue light reduces and delays the natural production of melatonin. This delays the onset of those sleepy feelings.
Blue light has also been shown to reduce the amount of time spent in stage 3 and REM sleep. These stages are vital for cognitive function and making you feel refreshed when you wake up. It is recommended to avoid all electronic devices leading up to bedtime. However, this may not be an option for some people. There are ways to negate some of the negative effects of blue light.
Establish a bedtime routine that omits electronic devices in the hour before you go to bed. Fill that time with relaxing activities instead.
Make your bedroom a screen-free zone. Avoid scrolling through social media or watching TV whilst in bed. Remove all devices so that you’re not tempted to use them.
If you need to use your devices in the hour before bed or in the bedroom, switch them into night mode. This mode decreases the blue light emissions and dims the screen. You may also want to invest in some blue light blocking glasses. These can be relatively inexpensive.
Self-hypnosis trains our mind to ignore peripheral awareness and focus more inwardly. This inward focus allows us to relax and re-orientate our thoughts and feelings. If you choose to see a hypnotherapist for sleep, they will give positive imagery and suggestion surrounding bedtime. This will ingrain positive associations and suggestions associated with sleep and your specific needs. Hypnosis can also help with symptoms of anxiety and depression. These are big factors which can inhibit good quality sleep.
Recordings of meditation or self-hypnosis can be helpful to use at home when you want to sleep.
The most credible recordings will come from a therapist but there are many recordings available to help you to relax and focus on yourself which can help you to sleep.
Allot Worry Time
Worrying has no limits. You could spend an infinite amount of time worrying about the same things over and over, or find a never-ending list of things to worry about.
Allotting a specific time to worry has shown to decrease anxiety and improve sleep in as little as two weeks.
Set aside a specific time everyday to allow yourself to worry. This time should be no more than 30 minutes. Try to make this at the same time everyday. Avoid making it too close to bedtime. Mark it in your calendar or add it to your schedule so that your time is blocked out. Any other time in the day that a worry comes in to your mind, place it to the back of your mind (some people write it down) until your allotted worry time. During your worry time, you are free to worry as much as you like about whatever you like. Some people just think about these things, others like to write them down. Practise worry time however suits you best. When the 30 minutes is up forget about your worries until your next allotted worry time and carry on with your day.
Limiting your worry time to just 30 minutes a day can make your worry time more productive as you are no longer ruminating on your concerns. You may find that your anxiety lessens and you are able to find more solutions to your worries and concerns.
When Should I Go To A Doctor?
Recognising when you should seek professional help is key to managing sleepless nights and the toll these can take on you. Common points at which you should seek professional advice would be:
When you have more than just occasional sleepless nights. If you are regularly dealing with insomnia, especially if it interferes with your everyday life.
When you have excessive daytime sleepiness. Being more sleepy than is usual during the day can be a symptom of not just insomnia, but other underlying health conditions. Excessive sleepiness can manifest itself as irritability or the lack of ability to concentrate.
You snore excessively, cough or splutter in the night. This is a common symptom of sleep apnoea and should be dealt with as soon as possible.
Changing your sleeping habits has not worked or made any difference to your sleep habits.
If you’re worried about the quality or quantity of your sleep it is always advisable to seek a professional opinion.
Some great resources you can easily access for more guidance and information about sleep: